FSGS Treatment Guidelines

Kidney International Supplement 2012, 6
Glomerulonephritis in 2012 the KDIGO treatment guidelines (Adult) 1 adult minimal change disease (MCD)

1.1 Adult MCD is the first treatment

1.1.1 Recommended use of hormones (1C) in the first treatment in patients with nephrotic syndrome.
1.1.2 The recommended single dose of prednisone or prednisolone daily 1mg/kg (maximum 80mg) every other day dose of 2 mg / kg (maximum 120mg) (2C).
1.1.3 The proposal achieved complete remission, but also tolerated the initial dose of hormones to maintain at least four weeks, if not to achieve complete remission, up for 16 weeks (2C).
1.1.4 in patients in remission, it is recommended that the hormone experienced six months of slow reduction (2D).
1.1.5 In patients with hormone relative contraindication to or can not tolerate large doses of hormones (if not control of diabetes, mental illness, severe osteoporosis, etc.), recommended oral cyclophosphamide or calcineurin inhibitors (CNIs), such as in frequent recurrence of MCD usage (2D).
1.1.6 is recommended that non-frequent recurrence, the initial dose and time of the hormone, such as 1.1.2, 1.1.3 and 1.14 are recommended (2D).

1.2 frequently relapse (FR) / steroid dependent (SD) MCD treatment

1.2.1 recommends oral cyclophosphamide 2-2.5mg/kg/d weeks. (2C).
1.2.2 recommended, despite the use of cyclophosphamide is still recurrence FR / SD MCD patients, or the need to preserve the reproductive function, the use of CNIs (the cyclosporine 3-5mg/kg/d tacrolimus, 0.05-0.1 mg / kg / d graded for 1-2 years (2C). 1.2.3 can not tolerate hormones, cyclophosphamide and CNIs, we recommend the use of mycophenolate mofetil (MMF) 500-1000mg daily treatments - 2 years (2D).

1.3 steroid-resistant MCD treatment

1.3.1 steroid-resistant MCD re-evaluate whether there are other reasons (no rating).

1.4 support treatment

1.4.1 the proposed merger of AKI in MCD patients, if it reaches the indications for renal replacement therapy, hormone therapy (treatment as the first of MCD) (2D).
1.4.2 During the first treatment of MCD patients with nephrotic syndrome does not recommend the use of the D class drug treatment of hyperlipidemia is not recommended in normal blood pressure, use of ACEI or ARB drop of urine protein (2D).
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The Kidney International, the Supplement 2012, 2 adults with idiopathic focal segmental glomerular sclerosis (FSGS) nephritis

2.1 Initial assessment of FSGS

2.1.1 full assessment to exclude secondary of FSGS (unrated).
2.1.2 is not conventional to do genetic testing (unrated).

2.2 initial treatment of FSGS

2.2.1 The recommended only in the nephrotic syndrome in patients with idiopathic FSGS, before considering the use of hormones and immunosuppressive therapy (1C).
2.2.2 prednisone daily single-dose administration, start the dose 1mg/kg/d (maximum 80mg / d) or every other day the dose 2mg/kg/d (maximum 120mg / d) (2C).
2.2.3 sufficient quantities of prednisone daily oral administration of at least four weeks, if tolerated, until relief up to 16 weeks (2D).
2.2.4 complete remission, it is recommended hormone slow the reduction of 6 months (2D).
2.2.5 dose corticosteroids contraindicated or not tolerated in patients (such as control of diabetes, mental illness, severe osteoporosis, etc.), it is recommended as first-line treatment (2D) using CNIs.

2.3 the treatment of recurrent

2.3.1 The recommended FSGS patients with nephrotic syndrome relapse treatment and relapse of recommended treatment options with adult MCD (2D).

2.4 steroid-resistant FSGS treatment

2.4.1 given CsA 3-5 mg / kg / d times serving at least 4-6 months (2B).
2.4.2 If a partial or complete remission, it is recommended that continued treatment for at least 12 months, and then slow reduction (2D). 2.4.3 for the hormone resistance can not tolerate the FSGS patients with CsA, the proposed joint use of MMF and high-dose dexamethasone therapy (2C).
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